The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis
Abstract Background The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear. Methods We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial...
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doaj-e7ea546e5d72472da92d14848e709d852021-09-19T11:44:57ZengBMCRespiratory Research1465-993X2021-09-012211910.1186/s12931-021-01839-0The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysisChing-Yi Chen0Chao-Hsien Chen1Cheng-Yi Wang2Chih-Cheng Lai3Chien-Ming Chao4Yu-Feng Wei5Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou UniversityDivision of Pulmonary, Department of Internal Medicine, MacKay Memorial HospitalDepartment of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic UniversityDepartment of Internal Medicine, Kaohsiung Veterans General HospitalDepartment of Intensive Care Medicine, Chi Mei Medical CenterDepartment of Internal Medicine, E-Da Cancer Hospital, Yan-Chao DistrictAbstract Background The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear. Methods We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial agents to those of placebo or usual care in the treatment of IPF patients. The primary outcome was all-cause mortality, and the secondary outcomes were changes in forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and the risk of adverse events (AEs). Results Four RCTs including a total of 1055 patients (528 receiving additional antibiotics and 527 receiving placebo or usual care) were included in this meta-analysis. Among the study group, 402 and 126 patients received co-trimoxazole and doxycycline, respectively. The all-cause mortality rates were 15.0% (79/528) and 14.0% (74/527) in the patients who did and did not receive additional antibiotics, respectively (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.76 to 1.51; p = 0.71). No significant difference was observed in the changes in FVC (mean difference [MD], 0.01; 95% CI − 0.03 to 0.05; p = 0.56) and DLCO (MD, 0.05; 95% CI − 0.17 to 0.28; p = 0.65). Additional use of antimicrobial agents was also associated with an increased risk of AEs (OR 1.65; 95% CI 1.19 to 2.27; p = 0.002), especially gastrointestinal disorders (OR 1.54; 95% CI 1.10 to 2.15; p = 0.001). Conclusions In patients with IPF, adding antimicrobial therapy to usual care did not improve mortality or lung function decline but increased gastrointestinal toxicity.https://doi.org/10.1186/s12931-021-01839-0AntibioticAntimicrobial agentCo-trimoxazoleDoxycyclineIdiopathic pulmonary fibrosisOutcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ching-Yi Chen Chao-Hsien Chen Cheng-Yi Wang Chih-Cheng Lai Chien-Ming Chao Yu-Feng Wei |
spellingShingle |
Ching-Yi Chen Chao-Hsien Chen Cheng-Yi Wang Chih-Cheng Lai Chien-Ming Chao Yu-Feng Wei The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis Respiratory Research Antibiotic Antimicrobial agent Co-trimoxazole Doxycycline Idiopathic pulmonary fibrosis Outcome |
author_facet |
Ching-Yi Chen Chao-Hsien Chen Cheng-Yi Wang Chih-Cheng Lai Chien-Ming Chao Yu-Feng Wei |
author_sort |
Ching-Yi Chen |
title |
The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis |
title_short |
The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis |
title_full |
The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis |
title_fullStr |
The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis |
title_full_unstemmed |
The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis |
title_sort |
effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis |
publisher |
BMC |
series |
Respiratory Research |
issn |
1465-993X |
publishDate |
2021-09-01 |
description |
Abstract Background The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear. Methods We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial agents to those of placebo or usual care in the treatment of IPF patients. The primary outcome was all-cause mortality, and the secondary outcomes were changes in forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and the risk of adverse events (AEs). Results Four RCTs including a total of 1055 patients (528 receiving additional antibiotics and 527 receiving placebo or usual care) were included in this meta-analysis. Among the study group, 402 and 126 patients received co-trimoxazole and doxycycline, respectively. The all-cause mortality rates were 15.0% (79/528) and 14.0% (74/527) in the patients who did and did not receive additional antibiotics, respectively (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.76 to 1.51; p = 0.71). No significant difference was observed in the changes in FVC (mean difference [MD], 0.01; 95% CI − 0.03 to 0.05; p = 0.56) and DLCO (MD, 0.05; 95% CI − 0.17 to 0.28; p = 0.65). Additional use of antimicrobial agents was also associated with an increased risk of AEs (OR 1.65; 95% CI 1.19 to 2.27; p = 0.002), especially gastrointestinal disorders (OR 1.54; 95% CI 1.10 to 2.15; p = 0.001). Conclusions In patients with IPF, adding antimicrobial therapy to usual care did not improve mortality or lung function decline but increased gastrointestinal toxicity. |
topic |
Antibiotic Antimicrobial agent Co-trimoxazole Doxycycline Idiopathic pulmonary fibrosis Outcome |
url |
https://doi.org/10.1186/s12931-021-01839-0 |
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